Sueda Shozo, Sakaue Tomoki
Department of Cardiology, Ehime Prefectural Niihama Hospital, Hongou 3 choume 1-1, Ehime Prefecture, Niihama City 792-0042, Japan.
Department of Cardiology, Yawatahama City General Hospital, Ohira 1-638, Ehime Prefecture, Yawatahama City 796-8502, Japan.
Eur Heart J Open. 2021 Aug 11;2(1):oeab012. doi: 10.1093/ehjopen/oeab012. eCollection 2022 Jan.
Intracoronary acetylcholine (ACh) testing is useful for the detection of epicardial spasm (ES) and coronary microvascular spasm (CMS). We retrospectively analysed the incidence of ES and CMS in consecutive Japanese patients with unobstructed coronary artery disease.
From January 1991 to February 2019, we performed intracoronary ACh testing of 1864 patients. Among these patients, a total of 746 consecutive patients (254 women, mean age 64 ± 11 years) who underwent first diagnostic angiography for suspected myocardial ischaemia and had unobstructed coronary arteries (<50%) were enrolled. Epicardial spasm was defined as ≥90% stenosis and usual chest symptoms and ischaemic ECG changes, while CMS was defined as <75% stenosis and usual chest symptoms and ischaemic ECG changes. We performed intracoronary ACh testing on both coronary arteries in 96% (716/746) of all subjects. Overall, ES was found in 329 patients (44%), whereas CMS was revealed in 40 patients (5%) including 4 patients with coexisting ES. In patients with ES, women made up 22%, and approximately three-quarters of the patients had resting chest pain. In contrast, women composed 65% (26/40) of those with CMS, and 15 patients with CMS had another chest symptom. Coronary microvascular spasm was frequently observed in the left coronary artery (LCA) but not the right coronary artery. Electrical cardioversion was necessary for two patients.
Coronary microvascular spasm was recognized in only 5% of consecutive Japanese patients with unobstructed coronary artery disease, whereas ES was revealed in 44% of those patients. Coronary microvascular spasm was often observed in women and in the LCA.
冠状动脉内乙酰胆碱（ACh）检测对于检测心外膜痉挛（ES）和冠状动脉微血管痉挛（CMS）很有用。我们回顾性分析了连续的日本冠状动脉无阻塞性疾病患者中ES和CMS的发生率。
1991年1月至2019年2月，我们对1864例患者进行了冠状动脉内ACh检测。在这些患者中，共有746例连续患者（254例女性，平均年龄64±11岁）因疑似心肌缺血接受了首次诊断性血管造影且冠状动脉无阻塞（<50%）而被纳入研究。心外膜痉挛定义为狭窄≥90%且伴有常见胸痛症状和缺血性心电图改变，而CMS定义为狭窄<75%且伴有常见胸痛症状和缺血性心电图改变。我们对所有受试者中的96%（716/746）的双侧冠状动脉进行了冠状动脉内ACh检测。总体而言，329例患者（44%）发现有ES，而40例患者（5%）发现有CMS，其中包括4例合并ES的患者。在ES患者中，女性占22%，约四分之三的患者有静息性胸痛。相比之下，女性占CMS患者的65%（26/40），15例CMS患者有其他胸痛症状。冠状动脉微血管痉挛在左冠状动脉（LCA）中常见，而右冠状动脉中不常见。两名患者需要进行电复律。
在连续的日本冠状动脉无阻塞性疾病患者中，仅5%的患者发现有冠状动脉微血管痉挛，而44%的患者发现有ES。冠状动脉微血管痉挛在女性和LCA中常见。
